Botulism (ICD-10-GM A05.1: Botulism) is a poisoning with paralytic symptoms caused by botulinum toxin (botulinum neurotoxins, BoNT).
The disease is caused by the bacterium Clostridium botulinum (very rarely also C. butyricum or C. baratii). This produces the botulinum toxin. Clostridium botulinum is a gram-positive flagellated rod bacterium. According to the toxin type, seven forms can be distinguished, with types A, B, E and F appearing to be particularly important. They are extremely potent neurotoxins (nerve poisons) that are lethal even in the smallest doses.
Occurrence: Infection occurs worldwide, often in small epidemics (3 to 5 cases) or as isolated cases.
Human-to-human transmission: No
The incubation period (time from infection to onset of disease) for foodborne botulism is usually 12-36 hours, but may be shorter or longer (up to 10 days). The decisive factor is the amount of toxin ingested.If the case is infant botulism, the incubation period cannot be determined.
Different forms of botulism can be distinguished according to the transmission of the pathogen (route of infection):
- Foodborne botulism – in this case, the toxin is ingested with food, especially through sausage and vegetables from cans and jars.
- Wound botulism – here the bacterium contaminates a wound.
- Infant botulism (infantile botulism) – in this form of botulism, the infant ingests the spores of the bacterium, toxins are then formed in the intestine; this, harmless to adults, is mainly triggered by honey
Botulism occurs very rarely in Germany. On average, circa 10 cases are reported per year (almost exclusively foodborne botulism). In the United States, infant botulism is the most common (100 to 110 cases/year).
Course and PrognosisFoodborne botulism:
The earlier the onset of symptoms, the more pronounced the intoxication and ultimately the higher the lethality. Depending on the type and amount of toxin, lethality (mortality relative to the total number of people affected by the disease) can be as high as 70%. With early antitoxin therapy, lethality can be reduced to about 5-10%. It takes months to years for a diseased person to fully recover.
Infant botulism: With progressive intoxication, more symptoms occur, e.g. dysphagia (difficulty swallowing). This form of botulism is discussed as a possible cause of sudden infant death syndrome.
In Germany, even the suspicion of botulism (detection of the pathogen or toxin) is reportable under the Infection Protection Act (IfSG).
